What is the recommended dosage of progesterone in relation to an enlarged prostate and elevated PSA?

Hi Catherine,

As a male, age 71, with an enlarged prostate and elevated PSA, and with a history of bladder cancer, what is the recommended dosage of natural Progesterone as well as application suggestion. I understand that this would be for information only with no expectation of any medical advice.

Thank you,

Joseph

Dear Joseph,

Men are often wary of taking progesterone supplementation for fear it will induce female characteristics. This couldn’t be further from the truth. It is the hormone estrogen that is responsible for the characteristics of the female body.

We know that the prostate gland responds to the hormones estradiol, progesterone, and testosterone, and that a man’s progesterone and testosterone levels fall as he ages. If, however, his estradiol levels continue to remain high he should consider himself in a state of ‘estrogen dominance’. And research right now is pointing an accusing finger at estradiol as an initiator and promoter of cancer.

The initiation of normal cells turning into cancer cells is the same for both the breast or uterus and the prostate gland. In these organs, cancer initiation is due primarily to estrogen dominance combined with lifestyle factors and/or toxic insults that predispose estrogen to become oxidised. If left untreated, prostate cancer tends to eventually metastasize to bones.

Unopposed estradiol can be lethal to both sexes.

Men make estradiol, but throughout most of their young and middle adult life they make more testosterone, sufficient to block female breast development. As a man ages, however, and his testosterone and progesterone levels gradually decline, he has a tendency to develop breasts.

Therefore, testosterone is a direct antagonist to estradiol.

But here’s the rub. Excess testosterone can spill over and become estrogen, causing water retention, prostate enlargement, atrophy of the genitals, decrease in libido, and cancer.

Being overweight is another factor to consider since fat cells convert into estrogens which then stimulate prostate growth.

As we know from breast cancer research, insulin resistance leads to estrogen dominance and an increased risk of breast cancer. It seems to be that the same pattern occurs in prostate cancer.

Regular exposure to xenoestrogens such as pesticides like home and garden sprays only add to the problem.

Middle aged men are not immuned to estrogen dominance that can lead to symptoms such as weight gain, large-than-normal breasts, gall bladder problems, anxiety and insomnia, and prostate enlargement that leads to urinary problems.

So what factors lead to metabolic imbalance that lead to prostate cancer?

• Metabolic acidosis - a disturbance of the body acid-base balance in which there is excessive acidity of the blood
• Trans-fatty acids
• Lack of essential Omega-3 fatty acids
• Excessive exposure to toxins
• Insifficient daytime sun exposure - Vitamin D deficiency and mitochondrial inhibition
• Thyroid deficiency may underlie many other deficiencies and oxidative damages

What do scientists believe actually causes prostate cancer?

• Estrogen dominance
• Testosterone deficiency
• Zinc deficiency
• Melatonin deficiency (insufficient nighttime sleep) which leads to estrogen dominance
• Use it or lose it (regular sexual activity is thought to be helpful)

Prostate problems are the fastest-growing health concern among men in Westernised countries, and the rate of prostate cancer is increasing steadily.

It is estimated that benign prostate disease affects over 40 percent of American men by age 50 and over 70 percent by age 60. And the most common symptom is trouble with urination.

The incidence of prostate cancer increases with age. The majority of men in the US will acquire prostate cancer if they live beyond 65.

Excluding some forms of skin cancer, prostate cancer is the most common type of cancer in men in Australia, with approximately 10,000 new cases diagnosed and approximately 2,500 deaths recorded each year.

It is a slow-growing cancer (more rapidly growing in younger men). For men over 65, the doubling time of a prostate cancer nodule is usually about 5 years (compared to the doubling time of a breast cancer nodule of about 3 to 4 months!).

PSA test for detection of prostate cancer

Prostate specific antigen (PSA) is produced within the prostate gland and within breast tissue. When abnormal crowding of normal cells in the prostate occurs, the cells produce more PSA which inhibits angiogenesis (the growth of blood vessels leading to a cancer tumor) of its neighbouring cells. One of the hallmarks of cancer cells is that they will induce angiogenisis that will increase the flow of blood to them.

Firm massage of normal prostate cells will increase PSA levels in the prostate. Therefore, PSA is a marker for increased crowding of normal prostate cells. Unfortunately, conventional medicine uses PSA levels as a marker for prostate cancer. However, most “occult” prostate cancer occurs without elevating the PSA level.

In Sweden, physicians rarely screen for prostate cancer or use radical therapies, choosing watchful waiting instead. Despite this, mortality rates for prostate cancer have declined in Sweden.

The current view of Australian medical authorities is that the PSA test should not be offered for screening purposes. This view is based on:

• Not everyone with increased levels of PSA has prostate cancer. Other prostate conditions, such as benign prostatic hyperplasia or prostatitis can cause increased PSA levels.
• For every biopsy procedure performed, only 1 in 3 men with an increased PSA test will be diagnosed with prostate cancer.
• While increased PSA testing since early the 1990s has led to a rise in the number of cases of prostate cancer detected, there has been no clear evidence that screening for prostate cancer saves lives. In Australia, there has been no change in the mortality rate from prostate cancer even with increased PSA testing.

In his publication Hormone Balance for Men: What Your Doctor May Not Tell You About Prostate Health and Natural Hormone Supplementation Dr John Lee argued that, “good references show that men early in the course of their prostate cancer generally have low testosterone levels and little or no elevation of PSA.”

The role of progesterone and testosterone

We know that progesterone in men is vital to good health. It is the primary precursor of their adrenal cortical hormones and testosterone. Men synthesise progesterone in smaller amounts than women do but it is still important.

Both progesterone and testosterone promote the p53 gene that leads to normal healthy cell apoptosis (normal cell death), which is important to cancer prevention.

Estradiol, on the other hand, promotes the Bcl-2 gene, a known oncogene that inhibits apoptosis and causes cancer.

Since progesterone is a potent inhibitor of 5-alpha-reductase, the decline of progesterone in aging males plays a role in increasing the conversation rate of testosterone to DHT.

Dihydrotestosterone (DHT) stimulates proliferation of prostate cells, more so than testosterone does, enlarging the prostate gland and narrowing the urethral channel, leading to urination problems, and speculation that elevated DHT is the cause of prostate cancer.

Inhibiting this conversion of testosterone to DHT is often a treatment goal for men with BPH.

Adding progesterone back into the body helps restore normal inhibition of 5-alpha-reductase, thus preventing testosterone from changing into DHT, which stimulates proliferation of prostate cells.

Reestablish healthy ratios

Basically, Dr. Lee suggests that men should aim at maintaining good levels of both progesterone and testosterone for preventing, and for treating prostate cancer. Reestablish healthy ratios between estradiol, progesterone and testosterone.

Testosterone levels in men aged 30 to 35 are 200~300 pg/ml. This level of testosterone does not hurt these 30 to 35 year old men and, according to Dr Lee, it will not hurt men who are 65 to 70 years old.

Therefore, to restore balance, we’re looking for:

• saliva progesterone levels 200~300 times that of estradiol (P/E2)
• saliva testosterone levels 200~300 times that of estradiol (T/E2)

Dr John Lee’s recommended dosages for men deficient in progesterone and/or testosterone:

• Transdermal progesterone … 5 to 8 mg/day
• Transdermal testosterone … 1 to 2 mg/day

Preventing and treating prostate cancer with hormone supplementation to maintain hormone balance, together with vitamin, minerals and diet seems makes good sense.

Establishing a baseline hormone profile before commencing BHRT, and retesting saliva levels 2 to 3 months into therapy is recommended

Suggested application sites

If there is a cyst or lump in the testes that has been tested and found to be benign then you can apply cream directly to the testes. A similar approach is adopted by women with fibrocystic breasts, and progesterone has certainly helped reduce if not eliminate lumpy breasts.

Apply cream to areas where the blood vessels are very close to the skin, avoiding fatty areas like the stomach and buttocks, and avoid areas where there are more than a few hair follicles.

Suggested areas for men where there is good blood supply is inside the groin, behind the knees, ankles, wrists, inside under your arms (not armpit), on the temples, forehead, neck, upper chest. It’s not necessary to apply progesterone cream directly to the penis … but you can if you want to!

Too much progesterone cream may cause fluid retention, headaches and other associated symptoms so please use only small maintenance dose of 5-8mg a day.

My recommendation to women holds true for men … take full responsibility for any hormone treatment, move away from compliance and ignorance, undertake your own research, carefully track your symptoms, get regular saliva hormone levels tests, and at every opportunity work closely with a collaborative health care professional.

P.S. Discussions around prostate cancer strike a personal note for me. Some time ago now, dad began to exhibit early signs of this disease so, on advice of his treating specialist, he submitted to radical preventative measures - a prostatectomy (removal of the prostate gland). This decision was tempered by the fact dad had survived cancer in one of his kidneys, that he’d already lost one brother to prostate cancer, and that another brother also diagnosed with prostate cancer was fighting for his life. Certainly, there appears to be a strong link to possible genetic mutations passed down through dad’s family, providing my three brothers with a wake-up call to be more vigilant now they are into their 40s.